Provider Demographics
NPI:1750477402
Name:MADOFF, STACEY ALISON (MD)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:ALISON
Last Name:MADOFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WESTAGE BUSINESS CTR DR STE 230
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-2288
Mailing Address - Country:US
Mailing Address - Phone:845-896-9864
Mailing Address - Fax:845-896-4319
Practice Address - Street 1:200 WESTAGE BUSINESS CTR DR STE 230
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-2288
Practice Address - Country:US
Practice Address - Phone:845-896-9864
Practice Address - Fax:845-896-4319
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210556207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0162825OtherGHI PPO
NY3C3538OtherHEALTHNET
NYP1238987OtherOXFORD
NY5371659OtherAETNA-HMO
NY79339OtherGHI HMO
NY10043447OtherCDPHP
NY364686OtherMOHAWK VALLEY PLAN
NY663E81OtherBLUE CROSS
NY3379505OtherAETNA
NY5371659OtherAETNA-HMO